Hesperetin Inhibits Bladder Cancer Cell Proliferation and Promotes Apoptosis and Cycle Arrest by PI3K/AKT/FoxO(3)a and ER Stressmitochondria Pathways.	BACKGROUND AND OBJECTIVES: Hesperetin (HSE) is a natural flavonoid derived from the hydrolysis of Hesperidin, which is mainly found in traditional natural Chinese herbs, such as Chenpi and Hovenia caryophyllus. HSE displays anti-inflammatory and antioxidant activities. However, its potential mechanism of action on bladder cancer (BLCA) remains unknown. The aim of this study was to investigate the potential mechanism of action of HSE on BLCA cells. METHODS: Network pharmacology analysis was used to construct a composite target network, combined with Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis to identify HSE-induced cell death patterns and signaling pathway alterations. Cytotoxicity evaluation was determined by CCK-8 assay. A clone formation assay was performed to assess cell proliferative capacity. Scratch and Transwell assays were performed to evaluate cell migration and invasion ability. Hoechst 33342 staining was visualized to observe morphological features of apoptosis. Apoptosis, cycle distribution, reactive oxygen species (ROS) generation, and mitochondrial membrane potential (MMP) changes were examined by flow cytometry. Western blot analysis was performed to analyze the expression of key proteins associated with cell proliferation, apoptosis, cycle block, PI3K/AKT/FoxO(3)a and endoplasmic reticulum (ER) stress-mitochondrial pathways. RESULTS: Network pharmacology analysis was performed to identify 155 potential candidate targets of HSE-BLCA, and further topological analysis was performed to obtain 34 hub-gene. Enrichment analysis yielded patterns of death and key pathways, revealing that the anti-BLCA effect of HSE may be related to the positive regulation of PI3K/AKT/FoxO(3)a and ER stress-mitochondrial pathways. in vitro results showed that HSE blocked cell proliferation, migration, and invasion in a concentration-dependent manner and triggered apoptosis, G0/G1 phase blockade, ROS production, and MMP depolarization. In addition, Western blot results showed that HSE downregulated phosphorylated (p)-3-phosphoinositide-dependent kinase-1 (PI3K), phosphorylated (p)-AKT serine/threonine kinase 1 (AKT), phosphorylated (p)-Forkhead box O(3)a (FoxO(3)a), anti-apoptotic proteins, proliferation-associated proteins, and cell cycle promoters, whereas the levels of proteins related to the expression of cell cycle regulators, pro-apoptotic proteins, and ER stress-mitochondrial pathway were up-regulated in BLCA cells by the intervention of HSE. PI3K agonist (YS-49) and ER stress inhibitor (4-PBA) partially or completely reversed HSE-mediated proliferation, apoptosis, and cycle blockade in BLCA cells. CONCLUSION: The anticancer effects of HSE in BLCA may be attributed to its coordination of actions, inhibiting cell proliferation, migration, and invasion, inducing apoptosis, G0/G1 phase arrest, generating reactive oxygen species, causing MMP loss, and engaging the caspase protein family. These actions are likely mediated through the PI3K/AKT/FoxO(3)a and ER stress-mitochondrial pathways. Thus, our findings suggest that HSE is a promising novel therapeutic candidate for the prevention and treatment of BLCA.	bladder